Professional sexual abuse: A perversion of attachment?
A challenge closely related to child abuse is that of ﬁghting sexual abuse of patients perpetrated by professionals. Towards the end of his life, Bowlby referred to this problem as a “hot potato”
(quoted in Hunter, 2015, p. 154). Indeed, attachment and care-giving are often expressed in terms of physical touch. And touch, although not inevitably, is also connected with sex. As we shall see below, Freud was quite alarmed when he realised that therapeutic encounters did sometimes involve sex. Bowlby was not totally against the occasional use of physical touch in therapy as
a caring gesture, because in certain circumstances it can have therapeutic value. But, he said, touch has to be used with quite a lot of discretion. In his opinion, all therapists should be aware of the patient’s attachment history, handle sexuality with ethical care and be particularly mindful in some dyadic situations. For example, in the therapeutic encounter between a middle-aged man and a young attractive girl, touch “could so much easily mean sex than anything else” (quoted in Hunter, 2015, p. 154). Current estimates indicate that at least 10 per cent of male and 3 per cent of
female psychotherapists violate sexual boundaries with their patients (Tschan, 2014). What today is documented as professional sexual abuse was not an uncommon occurrence in the early days of psychoanalysis. The traditional therapeutic couch became a place where sexual aﬀairs took place. Indeed, before the actual physical involvement, the intra-psychic boundary was the ﬁrst to disintegrate. For a long time, it seems, there was no clear understanding of professional boundaries – or was there? The problem is still substantial; all of us in the profession should be very alert
and collaborate with the aim of eradicating it. We have a duty to protect vulnerable people and to help them feel safe. Bowlby told me in supervision that it is important to understand the strength of unmet attachment needs that patients often
bring to therapy. He had pointed out several times that Freud himself had missed the centrality of attachment (Bowlby, 1958a, 1969). Some psychotherapists seem to misinterpret the patient’s strong needs for
attachment as sexual seductions; some of these therapists also give in and act out their own sexual feelings. That is sexual exploitation of a vulnerable person by someone who is in a position of power. I do not need to go into the incestuous meaning of this – and the parallel with child sexual abuse. The correspondence between professional abuse and child abuse is implicitly
reﬂected in the following:
In the past three decades we have begun to appreciate the prevalence of childhood sexual abuse and emotional abuse, how these lead to dissociative states and complex post-traumatic syndromes. Had I had that knowledge in the early 1970s, I believe that I could have held to the boundaries of the analytic situation with a young woman patient whose problems I now see more clearly as having emerged from such a complex traumatic syndrome. The traumata were re-enacted in the analysis…. Though I had been able to help colleagues and trainees with diﬃcult countertransference situations, I could not do that for myself and did not accept for myself imperative need for further personal therapy.